摘要
目的:探讨高频超声在剖宫产术后再妊娠阴道分娩产前评估中的应用价值.方法:选取2019年2月-2022年11月于本院产科分娩的有剖宫产史产妇80例,产前均实施高频超声检测并根据检测结果将80例产妇分为Ⅰ级瘢痕、Ⅱ级瘢痕、Ⅲ级瘢痕,对比不同分级产妇分娩情况及超声检测子宫下段肌层厚度及形态、滋养层动脉阻力指数、产程相关指标、新生儿Apgar评分等.结果:Ⅰ级瘢痕产妇剖宫产率最低,阴道分娩率最高,Ⅲ级瘢痕产妇剖宫产率最高且无阴道分娩;Ⅰ级瘢痕产妇子宫下段肌层厚度最厚,Ⅲ级瘢痕产妇下段肌层厚度最薄(均P<0.05).不同瘢痕分级产妇滋养层动脉阻力指数未见差异,不同瘢痕分级产妇分娩新生儿体重及Apgar评分无差异(均P>0.05).Ⅰ级瘢痕产妇手术产程用时最短、出血量与缩宫素用量最少,Ⅲ级瘢痕产妇产程用时最长、产时出血量与缩宫素用量最多(均P<0.05).80例中有61例经阴道分娩成功(76.3%),其中1例子宫破裂(1.6%),19例行剖宫产术(23.8%),均无产妇及围生儿死亡.结论:高频超声通过监测产妇子宫下段肌层厚度及形态可准确了解瘢痕愈合情况,对剖宫产瘢痕子宫再妊娠产妇分娩方式的选择有较高指导价值,使分娩方式合理化、安全化,提升瘢痕子宫再次妊娠阴道分娩率.
Objective:To explore the application value of the high-frequency ultrasound for evaluating the prenatal situation of pregnant women with cesarean section history who wanted vaginal delivery.Methods:80 pregnant women with cesarcan section history who had delivered in hospital from February 2019 to November 2022 were selected retrospectively.According to the results of the high-frequency ultrasound examination,these women were divided into group A(women with the grade.Ⅰscar of uterus),group B(women with the gradeⅡscar of uterus)and group C(women with the gradeⅢscar of uterus).The delivery situation,the thickness and morphology of the lower segment of the uterus muscle layer and the resistance index of trophoblastic artery evaluated by ultrasound,the labor process related indicators,and the neonatal Apgar score of the women were compared among the three groups.Results:The rate of the cesarean section the women during delivery in group A was the lowest,and the vaginal delivery rate was the highest.The cesarcan section rate of the women in group C was the highest,and there was no any woman with vaginal delivery in group C.The thickness of the lower uterine scgment muscle layer of the women in group A was the thickest,but which of the women in group C was the thinnest(all P<0.05).There were no significant differences in the trophoblastic artery resistance index of the women,and the neonatal weight and Apgar score among the three groups(all P>0.05).The labor duration,the amount of bleeding and the dosages of oxytocin used of the women in group A were the lowest,while which of the women in group C were the highest(all P<0.05).Among 80 pregnant women with cesarean section history,there were 61(76.3%)cases with sucessful vaginal delivery,1(1.6%)case with uterine rupture,and 19(23.8%)had been cesarean section again.There was no any maternal or perinatal death.Conclusion:The high frequency ultrasound can accurately identify the scar healing status of the women by monitoring the thickness and shape of their lower segment of the uterine muscle layer,and which has high guiding value for the selection of delivery mode of the pregnant women with scar uterus caused by cesarean section.can promote the rational and safe selection of the delivery methods of the women,and so as to improve the rate of the vaginal delivery of these women.
作者
丁莉
杨文惠
张月红
DING Li;YANG Wenhui;ZHANG Yuehong(Tongling Maternal and Child Health Care Hospital,Tongling,Anhui Province,244000)
出处
《中国计划生育学杂志》
2024年第1期212-215,共4页
Chinese Journal of Family Planning
关键词
剖宫产瘢痕子宫
再次妊娠分娩方式
高频超声
子宫下段肌层厚度及形态
瘢痕分级
分娩方式评估
Cesarean scar uterus
Delivery mode for pregnancy again
High-frequency ultrasound
Thickness and morphology of the lower segment of the uterus muscle layer
Scar grading
Delivery mode evaluation
